Objective: To examine the association of unmet social needs (USN) with depressive symptoms among Youth and young adults (YYA) with type 1 diabetes (T1D).

Methods: Data from the SEARCH Food Security ancillary study (2018-2020) were used to examine the cross-sectional association of USN with depressive symptoms among 685 YYA with T1D. The USDA Household Food Security Survey Module was used to measure household food insecurity over the past 12 months (food insecure (≥3 affirmations) vs. food secure). Participants were queried about their primary mode of transportation (personal vehicle vs other form of transportation) and if they had stable housing (all the time vs some or none of the time) over the past 90 days. Total number of USN (0-3) were calculated by summing these items. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression (CES-D) scale (scores 0-60). Linear regression was used to examine the association between number of USN and depressive symptom scores.
 
Results: Among YYA with T1D (mean age 23.4, SD 4.6 years), 17.1% had household food insecurity, 14.0% lacked adequate transportation, and 4.3% experienced unstable housing; 23.5% had one, 5.1% had two, and 0.9% had three USN. Mean (SD) CES-D score was 14.3 (11.9). Compared to YYA with no USN, those with 1 and 2-3 USN had depressive symptom scores 5.9 and 15.9 points higher, respectively (p<0.0001 for both exposure values), after adjusting for covariates.

Conclusions: USN among YYA with T1D are confluent and are jointly and cumulatively associated with depressive symptoms.

Objective: This study investigated the association between household economic status and body mass index (BMI) among Bangladeshi women.

Methods: This cross-sectional study used data from the 2014 Bangladesh Demographic and Health survey, a survey of 17,421 (weighted data) ever married 15-49 year-old women. Household economic status was measured by a wealth index categorized into quintiles. Using an Asia-specific cut-off, BMI was categorized into underweight, normal weight, and overweight/obese. The association between wealth and BMI categories was measured using logistic regression.

Results: The prevalence of underweight was 18.3% and was highest among women in the poorest quintile (50.4%), whereas the prevalence of overweight/obesity was 39.6% and was highest among women in the wealthiest quintile (64.4%). After multivariable adjustment, compared with women in the poorest wealth quintile (odds ratio 1.0), the odds ratios for being overweight/obese increased to 1.27 (95% Confidence Interval (CI) 1.11-1.45) to 1.61 (95 % CI 1.42-1.84) to 2.24 (95% CI 1.94-2.55) to 3.88 (95% CI 3.34-4.52) in quintiles 2, 3, 4, and 5, respectively (p-value for trend<0.001).

Conclusion: Overweight/obesity consistently increased with increasing wealth index among women of reproductive age in Bangladesh. These results contrast upper income countries, where obesity is more concentrated in lower socioeconomic groups. Food insecurity may play a key role. Achieving greater insight into the international differences in the association between wealth and BMI may generate strategies to control the growing prevalence of obesity globally.

Objective: According to the U.S. Department of Agriculture, food insecurity is an economic condition defined by lack of access to enough food to consistently support a household’s nutritional needs. As of 2018, over 600,000 South Carolinians struggled with food insecurity. Areas of low food access are often found in communities that are rural and/or have large racial/ethnic minority populations. The objective of this study is to examine the availability of grocery stores across South Carolina by geography and racial/ethnic group composition.  
 
Methods: A retrospective, cross-sectional study design will be used. Demographic characteristics will be obtained from the U.S. Census American Community Survey for years 2015-2019. Available grocery stores as of December 31, 2020 will be confirmed with the Data Axle Reference Solutions dataset. Comparisons will be made at the Census tract level, with the percent of racial/ethnic minority residents analyzed by the number of available grocery store outlets in the same area. Rural-Urban Continuum Codes (RUCC) will define geography. Choropleth maps will be used to display descriptive statistics.

Results: Preliminary results show that racial/ethnic minority groups have fewer available grocery store outlets in their communities, which may negatively impact their food security. Final results will be available in March 2021.

Conclusions: Grocery store outlets are more readily available to residents of white and urban communities in comparison to areas with a higher percentage of rural and racial/ethnic minority residents. A lack of grocery store outlets in certain areas may enhance food insecurity for families and negatively affect one’s overall health.

Objective: This interrupted time series study examined children’s dietary habits during the 2020 COVID-19 pandemic compared to the same calendar periods in 2018 and 2019.
 
Methods:  Parents of 231 elementary schoolers (ages 7-12) from a larger cohort completed the Beverage and Snack Questionnaire on 2-3 random days each week for 6 weeks in Spring and Summer. Foods were classified as healthy or unhealthy based on the Healthy Eating Index. Mixed models compared differences in means and changes in slope between years.
 
Results: Pre-pandemic (2018 to 2019), there were no significant changes in springtime consumption of healthy (B = 0.10 95CI 0.00 to 0.10) or unhealthy (B = 0.06, 95CI -0.12 to 0.24) foods. In spring 2020, healthy and unhealthy food consumption increased significantly; children consumed an extra 0.3 (95CI 0.16 to 0.45) healthy and 1.2 (95CI 0.96 to 1.50) unhealthy foods/day. Healthy food consumption accelerated by an extra 0.2 (95CI 0.06 to 0.34) foods/day during the pandemic. While there was a significant increase in unhealthy foods consumed during the pandemic summer compared to previous years, the increase was not beyond expected given previous trends in summer eating habits (B = 0.23, 95CI -.04 to .50). 

Conclusions: Increased unhealthy food consumption during the pandemic is concerning given the risk for accelerated weight gain during unstructured time. The pandemic school closures may have altered children’s health behaviors by mimicking an ‘extended summer vacation,’ devoid of external structure. This may contribute to an increase in childhood obesity, warranting public health intervention. 

Objectives: As Ghana modernizes, adolescents are increasingly exposed to body size ideals incongruent with traditional values. This study explored how attractiveness and body image are conceptualized among urban Ghanaian adolescents and how various sociocultural messages regarding body image influence food choice.
 
Methods: The Measurement, Evaluation, Accountability, and Leadership Support for NCDs Prevention (MEALS4NCDs) Project measured the nature and extent of unhealthy food marketing. For this study, 48 interviews were conducted with Junior High School students (ages 14-17) in six districts across Accra, Ghana, in July and August 2020. Transcripts were coded and analyzed thematically.
 
Results: Participants described attractive and unattractive characteristics, some conflicting with traditional African standards valuing larger body sizes. In discussing attractiveness among the same sex, males emphasized “muscularity,” “tall stature,” and “broad shoulders,” while females favored “wide hips” and “a Coca-Cola shape” Both sexes preferred a “flat stomach” and “stylish clothing and hair,” and thought “overweight” was “unattractive” and “unhealthy.” Most students aspired to change their figure and expressed a need to attain a certain body type to attract romantic partners, reduce physical limitations, and avoid social stigma. To achieve their desired body size, most participants admitted changing diets to the chagrin of their elders who preferred that they ate traditional foods in larger quantities.
 
Conclusions: Urban Ghanaian adolescents’ conceptualizations of attractiveness and body image were influenced by traditional African and modern values obtained from messaging within social networks and media. Future interventions might use social marketing to promote nutritious diets and reduce stigma about body size.

Objectives: Household food insecurity (HFI) is prevalent, despite government programs such as the Supplemental Nutrition Assistance Program (SNAP), and it can make diabetes management challenging. This study assessed the prevalence of HFI and SNAP participation among youth and young adults (YYA) with type 1 diabetes (T1D) or type 2 diabetes (T2D) living in South Carolina (SC).

Methods: Participants from SEARCH for Diabetes in Youth were surveyed in 2015-20 and included 413 T1D and 129 T2D (10-34 y; mean: 22.0 y) YYA from SC. Adult participants and parents of minors reported whether they received SNAP benefits and completed the USDA food security questionnaire, where affirming ≥3 items indicated experiencing HFI. Chi-square tests were used to evaluate whether the prevalence of HFI and SNAP utilization differed by demographic characteristics.
 
Results: In YYA with T1D, 22% experienced HFI, and Non-Hispanic blacks had the highest prevalence (32.4%, p=0.0107). Approximately 16% of YYA with T1D utilized SNAP benefits, with the highest prevalence among females (19%, p=0.0458) and Non-Hispanic blacks (28%, p=0.0002). In YYA with T2D, 34% experienced HFI and 43% received SNAP benefits. SNAP was used in 75% of T2D youth households compared to 40% of T2D young adult households (p=0.0173).
 
Conclusions: In these YYA with diabetes, the prevalence of HFI exceeded the national prevalence of 10.5% in 2019 and was higher in some groups than in others, suggesting unmet need among this population. Addressing this unmet need is important given that stable food access is essential to appropriate diabetes management.

Objectives: This presentation summarizes methods used to recruit participants for the Nutritious Eating with Soul (NEW Soul) study in partnership with Rare Variety Café. This 9-month behavioral intervention, led by a community health worker, examines the reach of a soul food, plant-based healthy eating program for African Americans. 

Methods: Participants were recruited in two cohorts. An online screening questionnaire prompted participants to select how they were introduced to the study based on a list of recruitment strategies.

Results: The three most reported recruitment methods were social media (23%), radio (22%), and friends and family members (20%). Other strategies included Rare Variety Café, current study participants and staff, websites, work, newspaper, and church. From 199 completed screener forms, 48 individuals were ineligible based on study restrictions. The three most common reasons for ineligibility consisted of: medication for diabetes, inability to travel to the downtown Columbia area where Rare Variety Café is located, and BMI out of the required study range. Successful contact was made with 100 of the 151 eligible individuals for a follow-up 1-on-1 Zoom conferencing meeting. Of these, 86 individuals were invited to an orientation session. Seventy-one individuals attended orientation and 43 completed baseline assessments and enrolled in the study. 

Conclusions: The most popular methods for recruiting African American adults for this nutrition study were social media, radio, and peers. These findings suggest that future nutrition interventions prioritizing participation from the African American community would experience the greatest engagement when applying these recruitment techniques.

Objectives: The objective of this research was to examine the association between fasting times and metabolic and inflammatory biomarkers after three months of a dietary intervention.

Methods: The Inflammation Management Intervention (IMAGINE) was an anti-inflammatory diet intervention with primary outcomes assessed at three months. Timing of dietary intake was assessed via three unannounced 24-h dietary recalls at both baseline and three months. Lipids and inflammatory biomarkers (IL6, CRP, TNF- α) were assessed via blood draws at both timepoints. Fasting times were calculated using the average time of the first dietary exposure after waking and average time of the last intake before bed. Linear mixed model analyses were used combining intervention and control participants.

Results: Participants in the lowest fasting time tertile (i.e., lower number of fasting hours per day) had significantly greater reductions in IL6 (1.46 vs. 1.87 pg/mL, P = 0.04), total cholesterol (175 vs. 189 mg/dL, P = 0.04), and insulin concentrations (8.30 vs. 10.69 mU/L, P = 0.01), compared to those in the highest tertile. For a one-minute increase in first mealtime, LDL increased by 0.07 mg/dL (P = 0.01). The interactions between fasting time and timepoint was statistically significant for both CRP (P = 0.03) and TNF-α (P = 0.02). Change in the mean CRP and TNF-α for a one-unit increase in fasting time was smaller at 3 months compared to baseline.

Conclusions: Longer fasting times are associated with higher CRP, TNF-α, cholesterol, LDL, and insulin. Eating breakfast late may be related to longer fasting time, which may partially explain the fasting time findings.

Objectives: Poor-quality diets and abnormal sleep patterns are common among police officers. Diet can affect chronic inflammation which may influence sleep quality. Associations were examined between the energy-density Dietary Inflammatory Index (E-DIITM) and sleep quality among police officers.

Methods: Data were from the Buffalo Cardio-Metabolic Occupational Police Stress Cohort with baseline in 2004-2009 (n=464), first follow-up in 2010-2014 (n=281), and second follow-up in 2016 (n=191). The E-DII was calculated based on food frequency questionnaire reporting. Sleep was measured objectively (wrist actigraphy) and subjectively (Pittsburgh Sleep Quality Index). Standard repeated-measures linear regression models were fit to examine cross-sectional relationships between E-DII and sleep quality. A second approach assessed longitudinal effects by computing changes in E-DII while adjusting for the baseline E-DII. Effect modification by shift status (day, evening, or night shift) was examined.

Results: Cross-sectionally, a 1-unit pro-inflammatory increase in E-DII was associated with a 1.3-minute increase in wake-after-sleep-onset (WASO, p=0.02). In models with both longitudinal and cross-sectional effects, with every 1-unit pro-inflammatory increase in change in E-DII score, WASO increased by 1.4 minutes (p=0.07) which was driven by those primarily working day shifts (β=3.33, p=0.01). A worsening of the E-DII over time led to an improvement in sleep efficiency (β=0.52, p=0.04) among night shift workers. Subjective sleep quality improved (β=-0.22, p<0.01) for every 1-unit increase in the change in E-DII score.

Conclusion: More pro-inflammatory diets were associated with a worsening of sleep quality in those working day shifts. Findings among those primarily working nights may be due to differential loss-to-follow-up.

Objectives: A previous study reported that overall use of dietary supplements among United States (U.S.) adults remained stable from 1999 to 2012. However, little is known about trends over the last ten years. We examined trends in dietary supplement use in recent cycles of the National Health and Nutrition Examination Survey (NHANES).

Methods: The NHANES, a serial cross-sectional study of non-institutionalized adults and children residing in the U.S., was used to estimate the prevalence of overall dietary supplements use among adults (age ≥19 y) between 2009 and 2018 (five continuous 2-year cycles). Information about dietary supplement use was collected in an in-home interview by asking the participants whether they used any dietary supplements in the preceding 30 days. Survey-weighted prevalence was calculated to be nationally representative of the U.S. population. We also evaluated the trends across cycles and conducted subgroup analyses by age, sex, race/ethnicity, education status, body mass index, and self-reported health status.

Results: Over five NHANES cycles, data from 28,415 adults ≥19 y were included in current analyses. The sample size ranged from 5,600 to 6,215 across survey cycles. Mean age was 47.2 years. The overall use of any dietary supplements increased between 2009 and 2018 (49.5% in 2009-2010 and 57.4% in 2017-2018, P for trend < 0.001). Use of four or more supplement products also increased from 7.8% to 14.1% between 2009-2010 and 2017-2018 cycles (Ratio = 1.94, 95% Confidence Intervals: 1.52, 2.48, P for trend < 0.001). The observed trend toward increasing was consistent across different age and sex groups, and more pronounced among participants with higher education, higher body mass index, and fair or poor self-reported health status.

Conclusions: The overall use of any dietary supplements among U.S. adults increased during the last ten years. The trend was robust among different population groups. Underlying reasons for these trends warrant further investigation.